Effect of epidural analgesia with ambulation on labor duration

Abstract

Background: Ambulatory epidural analgesia (AEA) is a popular choice for labor analgesia because ambulation reportedly increases maternal comfort, increases the intensity of uterine contractions, avoids inferior vena cava compression, facilitates fetal head descent, and relaxes the pelvic musculature, all of which can shorten labor. However, the preponderance of evidence suggests that ambulation during labor is not associated with these benefits. The purpose of this study is to determine whether ambulation with AEA decreases labor duration from the time of epidural insertion to complete cervical dilatation. Methods: In this prospective, randomized study, 160 nulliparous women with AEA were randomly assigned to one of two groups: AEA with ambulation and AEA without ambulation. AEA blocks were initiated with 15-20 ml ropivacaine (0.07%) plus 100 μg fentanyl, followed by a continuous infusion of 0.07% ropivacaine plus 2 μg/ml fentanyl at 15-20 ml/h. Maternal measured variables included ambulation time, time from epidural insertion to complete dilatation, stage II duration, pain Visual Analogue Scale scores, and mode of delivery. APGAR scores were recorded at 1 and 5 min. Results are expressed as mean±SD or median and analyzed using the t test, chi-square, or the Mann-Whitney test at P≤0.05. Results: The ambulatory group walked 25.0±23.3 min, sat upright 40.3±29.7 min, or both. Time from epidural insertion to complete dilatation was 240.9±146.1 min in the ambulatory group and 211.9±133.9 min in the nonambulatory group (P=0.206). Conclusion: Ambulatory epidural analgesia with walking or sitting does not shorten labor duration from the time of epidural insertion to complete cervical dilatation.